Your question: Round nose tip problem. Any suggestions? Hello. My nose is small but my nose tip is round. it looks however better from the side look but i dont like my front look. Is it possible to do a minor change only to the nose tipe ? Is this a lighter surgery? thank you

Dr. Denenberg's answer: Yes it's possible. How about elevating the tip and straightening the bridge, too? See the Web reference link, just below my response. I made two computer morphs of your nose, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.I simulated narrowing that tip, but I also made small changes to the bridge of the nose, and shortened the nose a bit, too.In fact, even when we try to work only on the tip, it's often necessary to change other features, too. For example, when the tip cartilages are strong enough to make the tip roundish, they are often also strong enough to hold the tip out farther away from the face. When the tip is made narrower, it wants to move back closer to the face, too, and we might lower the bridge so it still fits well with the tip, even if the patient wants to keep a small hump. In your morph, though, I removed the hump. I hope I explained that well enough.You should understand that the changes I demonstrated in the morphs require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the Web reference link on how to stay out of trouble while searching for a rhinoplasty surgeon.Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he'll change, and by how much he'll change them -- so you know whether it's enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer.

1) Proposed before and after:

Here's an animation of those changes. Give it a couple seconds to load:

... and almost every U.S. state, have come to Omaha
to see Dr. Denenberg. We put a red or white flag on each location: (click the map to see a huge blowup)

Plain talk about picking a plastic surgeon for your
first-time or revision rhinoplasty.

I do lots and lots of
revision rhinoplasties; I'll try to give you some advice here, to
maximize the chances that you'll be happy after surgery, and to minimize the
chances you'll need a revision.

Important!! How to tell whether your consultation was acceptable:

Photos. If a surgeon doesn't show you before and after
photographs, scratch him off of your list. Period. No exceptions.
Deal-breaker.

You pick a surgeon primarily from his before and after photos. Diplomas,
board certifications, hospital affiliations, academic appointment, and even
reputation tell you nothing: a surgeon is never tested for his skill, his
artistic eye, the quality of his outcomes, or even whether he cares that his
patients are happy.

You must see photos of other patients who had some features similar to
your nose. For example, if your nose has a wide and drooping tip, don't
accept profile-only photos of patients who had a hump carved down. You can't
see the width of the tip on a profile photo.

Revision nose operations are much more difficult than first-time
operations, so if you are consulting a surgeon about a revision operation,
you must see photos of his revision patients.

If you do see the surgeon's photos, but you don't love them, scratch him off
your list. You want to use a surgeon whose work you like. Don't assume that
he'll do great on you when he didn't do great on the other people.

Thought experiment: you are going to hire a portrait painter to paint
your portrait. Would you really hire the painter if he wouldn't show you
any of his other portraits?! No, it would never occur to you to hire
him. Well, now you're going to hire a surgeon to change your nose, in the
middle of your face, and you aren't going to insist on seeing examples of
his work, proof that he knows what he's doing? Think about it. Teach your
friends.

Communication. If the doctor treats you disrespectfully, scratch
him off your list. If he won't patiently listen to what you want for your
nose, same thing. How will he know how to make you happy if he won't hear
what you want for your nose?

If he conducts the consultation from behind his desk and doesn't examine
your nose, deal-breaker. If it's the nurse and not the surgeon who conducts
the consultation, run away fastest. All due respect to the nurse, she
doesn't know what's possible and what isn't. If the plan is to see the
surgeon for the first time on the morning of surgery, deal-breaker. For
sure.

Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off
your list. The morphing is crucial, so the surgeon can prove to you that he
understands exactly what your goals are. Also, if the surgeon recommends
some changes that you hadn't thought of, you need to see the morphs, so you
can see whether you like those changes.

Your intuition. If your gut tells you "no," don't use the surgeon.
Don't ever use a surgeon only because you know him, or your kids know him,
or he lives on your street, or your primary care doctor referred you to him,
or he did your breasts, or your tonsils, or your wisdom teeth, or you saw
his advertisement, or his awards.

I hear these stories all the time from my revision rhinoplasty patients.
You must do your own evaluation of any surgeon you visit. And by
"evaluation," again, we're talking mostly about seeing his photos and seeing
how well he communicates with you. Don't bother checking the surgeon's
licensure and board certification and hospital affiliations and all that;
it'll just distract you from what's important.

Conclusion. The fact is, the great majority of plastic surgeons who perform
rhinoplasty shouldn't be doing the operation. It's an incredibly difficult
procedure, technically demanding, requiring experience, skill, judgment, an
artistic eye, an
exceptional level of communication and thoughtfulness, and a rare level of
empathy and caring for the patient. No hospital board protects you by
judging the quality of a surgeon's rhinoplasties and prohibiting him from
operating if he's terrible. It's the wild, wild west out there, folks.

Rhinoplasty is by far the
most difficult of the facial plastic surgery operations. And revision
rhinoplasty is ten times more difficult than a first-time operation.

First, you need to consider whether things
didn't turn out great on your first operation because of some unusual circumstance with the surgery
or the healing, or whether things went wrong because your doctor was not
expert in rhinoplasty in the first place.

Evaluate your surgeon again. Read the section above, on how to evaluate a
surgeon for a rhinoplasty. If you saw lots of before and after photos
of your surgeon's other patients who got excellent results, in noses at least somewhat
similar to yours, then your surgeon probably knows what he is doing, and you
can consider letting him perform your revision. Even the very best surgeon
has the occasional disappointing result.

However, if, on looking back, you decide that you did not do excellent
research on your original surgeon -- perhaps you relied on a referral, or on
his board certification, without being able to see his photos -- then you
probably should not have him perform the revision. If he couldn't get you
close to your goal the first time because of a lack of skill, he will have
no chance at all on the second try, and then you'll be in the tough position
of looking for a third operation.

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Dr. Denenberg has been selected as one of America's Top Doctors by Castle
Connolly Medical Ltd.

The America's Top Doctor award is not a popularity contest. Unlike all the
local copycats and spin-offs, Castle Connolly allows only physicians to
nominate, and vote for, Top Doctors. The "America's Top Doctor" is a doctor who is voted into that
position by a national review of recognized experts in the doctor's
field. Dr. Denenberg is one of the rare doctors to receive that award every
year since the program began in 2001.

If Dr. Denenberg asked you to post or send better photos ...

Go here, to see how to position and take photos that are best for a
plastic surgeon's evaluation.